Survival and Appropriate Device Interventions in Recipients of Cardioverter Defibrillators Implanted for the Primary Versus Secondary Prevention of Sudden Cardiac Death

Background: Implantable cardioverter-defibrillators (ICD) implanted after an episode of ventricular tachyarrhythmia (VTA) or in patients at high risk of VTA lower the long-term mortality. Comparisons of the clinical outcomes of the two indications are scarce.
Methods: The study enrolled 360 consecutive ICD recipients. The device was implanted for secondary prevention in 150 patients, whose mean age was 60 ± 14 years, and mean left ventricular ejection fraction (LVEF) was 40 ± 16%, and for primary prevention in 210 patients, whose mean age was 61 ± 11 years, and mean LVEF was 31 ± 13%. All-cause mortality and time to first appropriate ICD therapy were measured.
Results: The two study groups were similar with respect to age and prevalence of coronary artery disease. Mean LVEF was higher in the secondary prevention group (P = 0.001). Cox regression analysis revealed a significantly shorter time to first appropriate ICD therapy in the secondary prevention group (HR = 0.51, 95% CI = 0.30 – 0.87, P = 0.01). Over a mean follow-up of 37 ± 19 months, the all-cause mortality in the overall population was 12.7%, and was similar in both subgroups (HR = 0.99, 95% CI = 0.55–1.77, P = 0.97).
Conclusions: The long-term mortality in this unselected population of ICD recipients was low. Patients treated for secondary prevention received earlier appropriate ICD therapy than patients treated for primary prevention. Long-term mortality was similar in both groups. The higher VT incidence of VTA was effectively treated by the ICD and was not associated with a higher mortality.     

Role of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia

Background and objective: Agents such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila are recognized as important causes of community‐acquired pneumonia (CAP) worldwide. This study examined the role of these ‘atypical pathogens’ (AP) among adult hospitalized patients with CAP. Methods: A prospective, observational study of consecutive adult CAP (clinico‐radiological diagnosis) patients hospitalized during 2004–2005 was conducted. Causal organisms were determined using cultures, antigen testing and paired serology. Clinical/laboratory/radiological variables and outcomes were compared between different aetiologies, and a clinical prediction rule for AP was constructed. Results: There were 1193 patients studied (mean age 70.8 ± 18.0 years, men 59.3%). Causal organisms were identified in 468 (39.2%) patients: ‘bacterial’ (48.7%), ‘viral’ (26.9%), ‘AP’ (28.6%). The AP infections comprised Mycoplasma or Chlamydophila pneumoniae (97.8%) and co‐infection with bacteria/virus (30.6%). The majority of AP infections involved elderly patients (63.4%) with comorbidities (41.8%), and more than one‐third of patients were classified as ‘intermediate’ or ‘high’ risk CAP on presentation (pneumonia severity index IV–V (35.1%); CURB‐65 2–5 (42.5%)). Patients with AP infections had disease severities and outcomes similar to patients with CAP due to other organisms (oxygen therapy 29.1% vs 29.8%; non‐invasive ventilation 3.7% vs 3.3%; admission to the intensive care unit 4.5% vs 2.7%; length of hospitalization 6 day vs 7 day; 30‐day mortality: 2.2% vs 6.0%; overall P > 0.05). Age <65 years, female gender, fever ≥38.0°C, respiratory rate <25/min, pulse rate <100/min, serum sodium >130 mmol/L, leucocyte count <11 × 10⁹/L and Hb < 11 g/dL were features associated with AP infection, but the derived prediction rule failed to reliably discriminate CAP caused by AP from bacterial CAP (area under the curve 0.75). Conclusions: M. pneumoniae and C. pneumoniae as single/co‐pathogens are important causes of severe pneumonia among older adults. No reliable clinical indicators exist, so empirical antibiotic coverage for hospitalized CAP patients may need to be considered.     

Subjective well-being and satisfaction with life in adults with spastic cerebral palsy: a pilot study of a randomized sample

The aim of this study was to explore subjective well-being and satisfaction with life in general and with participation, activities, and health, in adults with cerebral palsy (CP). A randomized sample of 50 individuals was drawn from a sample of 465 previous outpatients of a regional social paediatric centre in southern Germany. A psychological measure for well-being (Bern Questionnaire on Subjective Well-Being, adult form [BSW/A]) and a sociomedical measure (Life Satisfaction Checklist [LiSat-11]) were applied as outcome measures. Twenty-five individuals from 35 responders (nine males, 16 females; mean age 28y, SD 2y 7mo, range 25–33y) were evaluated completely. Nineteen participants had bilateral and six had unilateral spastic types of CP (Gross Motor Function Classification System Levels I n=5, II n= 5, III n =5, IV n= 8, and V n =2). Eighteen individuals had no or only minor intellectual disabilities. Subjective well-being and general satisfaction with life were not impaired in adults with CP. Joy of life (a subscale of the BSW/A) was even increased. Satisfaction with some areas of participation was reduced compared with a reference and clinical samples from Sweden. In conclusion, subjective well-being and general satisfaction with life are not decreased in adults with CP. The different levels of satisfaction with areas of participation in German and Swedish individuals with CP may be explained by differences of social inclusion.